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Overcoming Anxiety

When your body has an overactive stress response, there are tools and treatments that help can combat the constant worrying, irrational fears or panic attacks.

By Robin L. Flanigan

Back when our ancient ancestors needed to run from giant hyenas and cave lions, an important survival mechanism readied the body to react to threats. The “fight, flight or freeze” response, which flushes our systems with hormones like adrenalin and cortisol in order to rev up energy levels and sharpen the senses, is hard-wired into humans.

In modern life, we may still encounter exciting, demanding, and possibly dangerous situations. But for some of us, that interior alarm system gets triggered less by real peril and more by everyday stressors and our own minds.

When that happens, we call it anxiety. And when it happens on a constant basis—or to an extreme degree—we call it an anxiety disorder.

“Anxiety tricks us into thinking it’s going to protect us, but it tends to turn into chronic worry, making us even more anxious,” says Patricia Thornton, PhD, a psychologist in New York City who specializes in the treatment of anxiety disorders.

When the sympathetic nervous system gears up to prepare the body for battle, for whatever real or imagined reason, every organ in the body (and that includes the brain) gets in on the act. Heart rate accelerates, the liver releases more glucose, and the lungs grasp for more oxygen, for starters. Sweating and hyperventilating are offshoots of this process.

It’s the parasympathetic nervous system’s job to take over and return the brain and body to a state of calm.

Due to some combination of genetics, physiology and personality, some people fire up more easily and have a harder time backing off from code red. There’s a lot of evidence linking an overactive stress response to medical conditions like heart disease and high blood pressure, as well as to brain-based disorders like depression, anxiety, and addiction.

Anxious symptoms can be an aspect of depression—in fact, research suggests that up to three-fourths of people with a depressive disorder have “anxious features” during a depressive episode and/or a co-existing anxiety disorder.

An anxiety diagnosis typically follows when symptoms—notably racing thoughts, restlessness, and physical distress such as nausea—occur on more days than not over six months, independent of any depressive episode, and significantly affect performance at home, work or school. Anxiety disorders affect from 20 to 25 percent of North Americans.

In some cases, feeling anxious can make you more productive and successful, as when you study harder for a test that you’re nervous about. More often, anxiety disorders tend to shrink the boundaries of your life.

If you’re afraid of flying, you might not pursue your dream to go abroad. If social activities make you panic, it’s harder make friends. A loop of irrational worries will sap your energy and attention from other things.

Yet treatment with medication, psychotherapy and stress-management techniques is generally very effective.

Facing fears

Because anxiety can take different forms, talk therapy should be tailored to specific symptoms. For example, cognitive behavioral therapy works well for the free-floating worry of generalized anxiety disorder. This treatment centers around changing the way you think and, therefore, the way you feel and act.

“Learning how to manage an anxious mind is a skill, but you can learn how to be active, thoughtful, more objective and better prepared for situations that you know are going to stress you out,” says clinical psychologist Nick Forand, PhD, director of evidence-based psychotherapy and an assistant professor at Hofstra University’s Northwell School of Medicine on Long Island.

Fretting over a situation (rumination) can stir up the stress response. So can a tendency to anticipate the worst (catastrophic thinking), no matter how unrealistic that outcome may be.

With depression and anxiety, “thoughts can be biased toward the catastrophic,” explains Forand. “We teach people to interrogate those thoughts, to be a bit more objective about those predictions they’re making. What’s the actual likelihood that this is going to happen, and where’s the evidence? Have you been in this situation before, and what happened?”

Forand notes that correcting your predictions often requires putting yourself into the very situation that makes you anxious. It’s natural to try to avoid things that set you off, whether spiders or public speaking. But every time you survive a dreaded thing or activity, you have more evidence that your fears were unfounded.

Confronting what you fear in a safe and manageable way is the essence of exposure therapy, which is useful for specific phobias.

According to Eilenna Denisoff, PhD, CPsych, clinical director at the psychotherapy practice CBT Associates in Toronto, it’s important to ride out the body’s stress response. She uses “running scared” for illustration: The adrenalin burst that fuels that “escape from an attacking dog” pace lasts only so long.

“To change behavior, you need to stay in the situation long enough for the anxiety to come down naturally on its own. And on repeated exposure, the brain learns that the feared situation is not as dangerous or intimidating as originally thought,” she says.

Therapists often use what’s called the Subjective Units of Distress Scale, or SUDS, to measure fear and anxiety. The scale goes from zero (“totally relaxed”) to 100 ( “highest distress/fear/anxiety/discomfort that you have ever felt”).

Say the prospect of meeting new people puts your SUDS level at 50 (“uncomfortable but can continue to perform”). A step-by-step approach to reducing that number to 25—somewhere between mild and minimal anxiety/distress—might start with greeting someone in an elevator, then move on to chatting about the weather while waiting in line. Eventually you may get comfortable enough to express opinions in front of a group.

If you get overly nervous about driving, you might start with 10 minutes a day piloting through a quiet neighborhood, then increase the length of time behind the wheel, then go onto major roads during an off-peak time of day, then during busier times, and so on.

Many people also experience anticipatory anxiety—symptoms that flare up when you simply think about facing something that scares you. It’s also not uncommon to dread the idea of having an anxiety attack if you’re going to be in a stressful situation, reinforcing the whole cycle.

Denisoff says it’s not important to get your SUDS level down to zero. Rather, the goal is reducing anxiety to a tolerable level because “you don’t want to be afraid of your own physiology. … When you fear the fear, it activates your alarm. You have to teach your brain to not fight.”

Medication & acceptance

Anyone who has been through a panic attack can attest that it’s a dreadful experience. Rod, a retired pastor from New York state, was halfway around the world when he was hit with what felt like a heart attack.

Rod had been feeling anxious over deadlines and other daily pressures before leaving for a trip to Kenya, where his congregation was partnering with a university. Five days into the two-week trip, in a meeting with the university’s president, he felt intense chest pain, as if someone were standing on his torso.

Anxiety disorders often are difficult to diagnose because physical symptoms like heart palpitations, dizziness, shortness of breath and headache mimic a number of medical conditions. However, when Rod was rushed to the hospital, a doctor confirmed he had no cardiac issues. It was a psychologist back home who identified what happened as a panic attack.

Rod started to get a handle on his anxiety after getting his hands on the book Don’t Panic: Taking Control of AnxietyAttacks, by clinical psychologist R. Reid Wilson, PhD.

“My copy is now underlined and has exclamation points and red and blue underlining,” says Rod.

He has found the meditation exercises in the book to be the most helpful. They’ve become part of his daily devotional, though he also calls on the technique as needed.

“Meditation is a form of acceptance,” says the pastor, who also takes a low dose of anxiety medication. “An hour after you’ve done your meditation, the same symptoms can occur, but now, instead of saying, ‘Dang it, here it comes again,’ I just tell the anxiety, ‘I’ve got to do things today that I think are important, and if you want to come along, come along.’”

While meditation and other mindfulness practices aren’t a magic bullet for treating anxiety—no single treatment is—new studies steadily roll out illustrating how the practice reduces symptoms.

For example, findings published in the January 2017 issue of Psychiatry Research showed that an eight-week course in Mindfulness-Based Stress Reduction helped people with generalized anxiety disorder handle stress better than an eight-week stress management education course focused on habits such as diet, sleep, and other wellness markers.

Keep calm & carry on

Any activities that help reduce stress will be helpful for anxiety. Yoga, for example, has documented benefits for reducing anxious and depressive symptoms. So does exercise in general. Focusing on the breath—taking five deep breaths or adopting a pattern like breathing in for eight counts and out for four counts—works for many people.

Individuals often hit upon their own tricks, too, such as rubbing a worry stone or listening to soothing music. Andrea sets a timer for somewhere between 12 and 17 minutes (“Don’t ask why I don’t just do 15; I don’t know,” she says) and lies down with her eyes closed until the buzzer rings.

It is one of many tools the professional blogger from South Florida has used in recent years to keep anxiety at bay. She also swears by improving her diet. She once subsisted mostly on fried foods, sugary snacks, and caffeinated drinks. She switched to healthier foods reputed to boost levels of serotonin, a neurotransmitter involved in regulating mood.

“A proper diet will balance your entire body,” she says. “It might not get rid of the problem completely, but it helps.”

At her worst, she recalls, she frequently found herself sitting on the floor, gasping for air, hoping not to pass out. In college, her panic at the thought of being surrounded by new people was so bad she needed her roommates to drive her to classes.

In time her attacks became less severe: She would feel dizzy and nervous, her heart would race, and her hands would be clammy, but she could function fairly well until her symptoms subsided.

Realizing that she won’t be overwhelmed by anxiety has been liberating.

“If I worry about being scared, then I’m adding an additional concern to my day,” Andrea says. “I have to know that the feelings are valid, but then I move on. I let it play out how it’s supposed to, and it eventually goes away.”

* * * * *

What, me worry?

In anxiety disorders, symptoms often are triggered by internal signals—thoughts and interpretations of events—rather than external threats of physical harm.

If we don’t resolve those negative patterns, “we end up re-creating exactly what we were trying to avoid in the first place,” says Colorado psychotherapist Laurie Weiss, PhD, author of Letting It Go: Relieve Anxiety and Toxic Stress in Just a Few Minutes Using Only Words.

It helps to:

Rein in the what-ifs. To get worries out of your head, write them down. (You can also sing them, or record them into your phone.) Use a timer and don’t go over 15 minutes, advises psychologist Patricia Thornton, PhD.

“You might think you’re doing something about your anxiety by thinking about every permutation of a situation,” she says. “But that just makes you more anxious—and keeps you from living your life.”

Find calming cues. When Rod Rod’s anxiety was at its peak, he would hum Simon & Garfunkel’s “Sounds of Silence,” which opens with the lyrics, “Hello darkness, my old friend/ I’ve come to talk with you again.”

“The anxiety was a form of darkness because I felt out of control,” he says. “But when you have the ability to know what’s happening to you, to deal with it immediately and accept it immediately, you can get on with your day.”

Avoid quick fixes. Alcohol, drugs, avoidance behavior and other short-term solutions won’t do anything to help you cope the next time anxiety strikes. Instead, acknowledge that anxiety is a natural alarm system, seek support, and learn stress-reduction techniques to prevent it from taking over your life.

A who’s who of anxiety

Generalized Anxiety Disorder: Exaggerated anxiety and tension that is not tied to something specific, persists for months, and can impair normal life and relationships. GAD, which affects twice as many women as men, causes people to anticipate catastrophe and worry excessively about anything from serious issues to routine concerns to events with very little likelihood of actually happening.

Panic Disorder: Unexpected and repeated episodes of intense fear accompanied by physical symptoms such as chest pain, heart palpitations, shortness of breath, dizziness or abdominal distress. Panic attacks can occur at any time, even during sleep.

Social Anxiety Disorder: Overwhelming anxiety or excessive self-consciousness in everyday social situations. Social phobia, as it’s also known, can be generalized or pegged to a particular activity, such as eating in front of others.

Obsessive-Compulsive Disorder: Obsessions are repetitive thoughts or impulses, such as a fear of getting an infection or fear of hurting a loved one. Compulsions are repetitive behaviors that people perform in an attempt to control or decrease anxiety—constantly checking that an oven is off to prevent a fire, frequent cleaning or hand-washing to avoid germ contamination, or ritualistic behaviors like flicking a light switch a specific number of times.

Post-Traumatic Stress Disorder: Exposure to a terrifying event in which grave physical harm might or did occur, or exposure to something emotionally traumatic, can lead to hypervigilance, nightmares, flashbacks, hostility, social withdrawal, irritability, and other depressive and anxious symptoms.

Sources: Brain & Behavior Research Foundation and Anxiety and Depression Association of America.